Laparoscopic heminephrectomy in infants and children: first 54 cases.
OBJECTIVE
Heminephrectomy in the pediatric population remains a popular open surgical procedure. We describe our experience with laparoscopic heminephrectomy using a retroperitoneoscopic approach.


METHODS
Data were collected retrospectively and prospectively on all patients undergoing laparoscopic heminephrectomy by a single surgeon using a prone retroperitoneoscopic approach. Information relating to the age, sex, laterality, duration of surgery, analgesic requirements, duration of hospital stay, postoperative complications and outcome was recorded.


RESULTS
Between March 2001 and August 2005 54 laparoscopic heminephrectomies were performed in 48 children (34 girls and 14 boys). The median age at surgery was 14 months (range 2-112 months). Forty-four upper and 10 lower moieties were removed. The median operative time was 105 min (range 50-150 min). There were no intraoperative complications and no conversions. There were four minor complications, comprising haematuria (n=1) and postoperative pyrexia (n=3). The median length of follow up was 22 months (range 3-57 months). All patients remained asymptomatic at last follow up. Ultrasound findings included presence of a visible ureteric stump (n=7) and cysts at the resection margin of the remaining remnant (n=17); none of these patients manifested clinical symptoms (e.g. infection, pain).


CONCLUSIONS
With advanced laparoscopic skills, laparoscopic heminephrectomy is a feasible operation for the treatment of non-functioning duplex renal units in children and infants.
Mushtaq
I
I
Department of Paediatric Urology, Great Ormond Street Hospital for Children and Evelina Children's Hospital, Great Ormond Street, London WC1N 3JH, UK. mushti@gosh.nhs.uk
Haleblian
G
G